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When to Start Antiretroviral Therapy

Antiretroviral therapy (ART) is the use of HIV medicines to treat HIV infection. ART is recommended for everyone who has HIV. ART helps people with HIV live longer, healthier lives.

People with HIV should start ART as soon as possible. In people with HIV who have the following conditions, it's especially important to start ART right away: pregnancy, AIDS, certain HIV-related illnesses and coinfections, and recent HIV infection. (Recent HIV infection is the period up to 6 months after infection with HIV.)

Before starting ART, people with HIV discuss the benefits and risks of ART with their health care providers. They also discuss the importance of medication adherence—taking HIV medicines every day and exactly as prescribed.

Pregnancy
All pregnant women with HIV should take HIV medicines to prevent mother-to-child transmission of HIV. The HIV medicines will also protect the health of the pregnant woman.

All pregnant women with HIV should start taking HIV medicines as soon as possible during pregnancy. In general, women who are already taking HIV medicines when they become pregnant should continue taking HIV medicines throughout their pregnancies. When HIV infection is diagnosed during pregnancy, ART should be started right away.

A CD4 count less than 200 cells/mm3. A low CD4 count is a sign that HIV has severely damaged the immune system.

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Illness with an AIDS-defining condition. AIDS-defining conditions are infections and cancers that are life-threatening in people with HIV. Certain forms of lymphoma and tuberculosis are examples of AIDS-defining conditions.

HIV-related illnesses and coinfections
Some illnesses that develop in people with HIV increase the urgency to start ART. These illnesses include HIV-related kidney disease and certain opportunistic infections (OIs). OIs are infections that develop more often or are more severe in people with weakened immune systems, such as people with HIV.

Coinfection is when a person has two or more infections at the same time. Coinfection with HIV and certain other infections, such as hepatitis B or hepatitis C virus infection, increases the urgency to start ART.

Recent HIV infection
Recent HIV infection is the period up to 6 months after infection with HIV. During recent HIV infection, the level of HIV in the body (called viral load) is very high. A high viral load damages the immune system and increases the risk of HIV transmission.

ART is an important part of staying healthy with HIV. Studies suggest that these benefits begin even when ART is started in recent HIV infection. In addition, starting ART during recent HIV infection reduces the risk of HIV transmission.

Once a person starts ART, why is medication adherence important?

Before starting ART, people with HIV discuss the benefits and risks of ART with their health care providers. They also discuss the importance of medication adherence—taking HIV medicines every day and exactly as prescribed. Adherence to an HIV regimen prevents HIV from multiplying and destroying the immune system. Taking HIV medicines every day also reduces the risk of HIV transmission.

Before starting ART, it’s important to address issues that can make adherence difficult. For example, a busy schedule or lack of health insurance to cover the cost of HIV medicines can make it hard to take HIV medicines consistently. Health care providers can recommend resources to help people deal with any issues that may interfere with adherence.

Read the following AIDSinfo fact sheets to learn more about medication adherence: